• N Schuitemaker, J van Roosmalen, G Dekker, P van Dongen, H van Geijn, and J B Gravenhorst.
• Department of Obstetrics, Leiden University Hospital, The Netherlands.
• Acta Obstet Gynecol Scand. 1997 Apr 1; 76 (4): 332-4.

BackgroundTo assess cesarean section-related maternal mortality in The Netherlands during 1983-1992.MethodsA nationwide confidential enquiry into the causes of maternal death.ResultsThe risk of dying after vaginal birth was 0.04 per 1000 vaginal births (65/1.763.999) compared to 0.53 per 1000 cesarean births (57/108.587). The direct risk of dying from cesarean section was 0.13 per 1000 operations (14/108.587). In some women cesarean section did not initiate, but contributed to, the train of events leading to death. Adding this associated risk to the direct risk gives a fatality rate of 0.28 per 1000 cesarean births (30/108.587).ConclusionsAlthough cesarean section is a relatively safe procedure nowadays, birth by cesarean section in The Netherlands is seven times more hazardous than vaginal birth. Keeping the cesarean birth rate as low as possible is therefore in the interest of women of reproductive age.

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